Pediatric crowns

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Pediatric crowns are dental crowns that provide full coverage for primary teeth. They can be made of different materials including stainless steel, polycarbonate, zirconium, or composite resin. [1]

Contents

Indications

Pediatric dentistry requires procedures with good long-term durability, due to the difficulty of working with young patients. Additionally, fear of dentistry and poor cooperation is common in pediatric dentistry. Therefore, simple procedures, like crowns, are an excellent choice and have excellent long-term prognosis. Pediatric crowns are often indicated for

Types


Many different types of pediatric crowns are available that can be classified based on how they are retained

  1. Those that are luted
  2. Those that are bonded to the tooth [2]

Luted crowns - Stainless Steel

Luted crowns use a cement that largely retains the tooth via mechanical retention. Stainless steel crowns (SSCs), also known as silver crowns were first described in the 1950s by Engel. [3] They exist in different forms, either completely made of metal (preformed metal crowns) or with a layer of composite material covering the metal to improve esthetics (open-faced SSCs or pre-veneered SSCs). [1] [2]

Preformed metal crowns (PMCs)

Preformed metal crowns (PMCs) are available untrimmed, trimmed, or pre-contoured, with the latter having minimum chairside time for best fit and requiring the least modification. In addition to the general indication for crowns, PMCs are indicated for: [1] [2]

  • In place of dental fillings as prevention of recurrent lesions for children with high caries risk
  • In place of dental fillings for children who require general anesthetic for treatment
  • Severe bruxism
  • Use in primary molars but also in permanent molars as an interim measure in a growing child

PMCs are durable, corrosion resistant, and cost effective. They are also less technique technique sensitive compared to dental fillings and have a lower failure rate compared to large fillings. [4] [5] However, PMCs cannot be used in partially erupted teeth, [1] are unesthetic due to their metallic appearance, and cannot be used in those with a nickel allergy. [2]

Open-faced and pre-veneered crowns

To address the unesthetic appearance of PMCs, a layer of composite resin or porcelain can be placed on the esthetic side of the tooth in open-faced and pre-veneered SSCs, respectively. While esthetics are improved, the improvement is compromised by limited shade selection, poor color stability, and visible metal margins. Additionally, preparing the tooth to accommodate these crowns may required more tooth removal. Furthermore, bonding and cementing these crowns is more technique sensitive. Finally, there is some concern over their longevity compared to PMCs. [6]

Bonded crowns

Bonded crowns use a resin-based cement that adheres the crown to the tooth via chemical bonding. These crowns are made from various tooth-colored materials, which are more aesthetic, but require better clinical technique to execute.

Composite resin-based crowns

Composite resin crown

Composite resin crowns, also called strip crowns, are made by curing composite resin within a clear plastic mold over a prepared tooth. [1] [2] They are widely used for restoring the primary anterior teeth (e.g. due to early childhood caries) and discolored teeth. These crowns are aesthetic, affordable, and conservative, requiring minimal enamel removal. [1] [2] However, they are technique sensitive to place, and are more likely to fail if oral hygiene is inadequate. [2]

New Millenium crowns

New Millenium Crowns are like strip crowns made from laboratory-enhanced composite resin material making them more expensive. Additionally, they are known to be very brittle. [1] [2]

Copolyester-based crowns

Polycarbonate crowns

Polycarbonate crowns are made from polyesters of carbonic acid and are molded to shape at high temperature and pressure. They have similar indications to strip crowns as polycarbonate crowns are also tooth colored. However, due to their brittleness and low abrasion resistance they are less frequently used than strip crowns. [1] [2]

Pedo jacket crowns

Pedo jacket crowns are made from tooth-colored copolyester outer crown form (“jacket”) which is filled with a resin material. Unfortunately, pedo jacket crowns are only available in one shade and cannot be trimmed/reshaped with a bur as the material will melt. [1] [2]

Glass-based - Artglass crowns

Artglass crowns are made from polymer glass with fillers (e.g. micro-glass and silica) to improve their durability and aesthetics compared to strip crowns. [2]

Ceramic-based - Zirconia crowns

Pediatric zirconia ceramic crowns are made of zirconium oxide stabilized with yttrium oxide. These are highly durable and are used for restoring both primary anterior and posterior teeth. [7] They have been in use for children since 2010. [8] [9] Zirconia crowns are indicated for patients exhibiting bruxism, with a nickel-chromium allergy, or those requiring general anaesthesia for dental treatment. Compared to stainless steel crowns, zirconia crowns may cause less gingival inflammation initially after placement. [5] [10] While zirconia crowns show lower failure than other tooth-coloured crowns (e.g. strip crowns), they are more expensive. [2]

There is insufficient clinical evidence to suggest the superiority of one type of paediatric crown to others. Many of these crowns have been used very successfully by dentists though there is inadequate good quality clinical evidence. The final decision of crown type considers factors of child cooperation, and parents' aesthetic preferences and financial situation. [2]

Related Research Articles

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<span class="mw-page-title-main">Bridge (dentistry)</span> Dental restoration for missing teeth

A bridge is a fixed dental restoration used to replace one or more missing teeth by joining an artificial tooth definitively to adjacent teeth or dental implants.

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<span class="mw-page-title-main">Crown (dental restoration)</span> Dental prosthetic that recreates the visible portion of a tooth

In dentistry, a crown or a dental cap is a type of dental restoration that completely caps or encircles a tooth or dental implant. A crown may be needed when a large dental cavity threatens the health of a tooth. Some dentists will also finish root canal treatment by covering the exposed tooth with a crown. A crown is typically bonded to the tooth by dental cement. They can be made from various materials, which are usually fabricated using indirect methods. Crowns are used to improve the strength or appearance of teeth and to halt deterioration. While beneficial to dental health, the procedure and materials can be costly.

<span class="mw-page-title-main">Deciduous teeth</span> First set of teeth in diphyodonts

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<span class="mw-page-title-main">Dental composite</span> Substance used to fill cavities in teeth

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<span class="mw-page-title-main">Inlays and onlays</span> Restoration procedure in dentistry

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<span class="mw-page-title-main">Temporary crown</span>

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<span class="mw-page-title-main">Glass ionomer cement</span> Material used in dentistry as a filling material and luting cement

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<span class="mw-page-title-main">Luting agent</span>

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<span class="mw-page-title-main">CAD/CAM dentistry</span> Computer-aided design and manufacturing of dental prostheses

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Adhesive dentistry is a branch of dentistry which deals with adhesion or bonding to the natural substance of teeth, enamel and dentin. It studies the nature and strength of adhesion to dental hard tissues, properties of adhesive materials, causes and mechanisms of failure of the bonds, clinical techniques for bonding and newer applications for bonding such as bonding to the soft tissue. There is also direct composite bonding which uses tooth-colored direct dental composites to repair various tooth damages such as cracks or gaps.

<span class="mw-page-title-main">Pulpotomy</span>

Pulpotomy is a minimally invasive procedure performed in children on a primary tooth with extensive caries but without evidence of root pathology. The minimally invasive endodontic techniques of vital pulp therapy (VPT) are based on improved understanding of the capacity of pulp (nerve) tissues to heal and regenerate plus the availability of advanced endodontic materials. During caries removal, this results in a carious or mechanical pulp exposure (bleeding) from the cavity. During pulpotomy, the inflamed/diseased pulp tissue is removed from the coronal pulp chamber of the tooth leaving healthy pulp tissue which is dressed with a long-term clinically successful medicament that maintains the survival of the pulp and promotes repair. There are various types of medicament placed above the vital pulp such as Buckley's Solution of formocresol, ferric sulfate, calcium hydroxide or mineral trioxide aggregate (MTA). MTA is a more recent material used for pulpotomies with a high rate of success, better than formocresol or ferric sulfate. It is also recommended to be the preferred pulpotomy agent in the future. After the coronal pulp chamber is filled, the tooth is restored with a filling material that seals the tooth from microleakage, such as a stainless steel crown which is the most effective long-term restoration. However, if there is sufficient remaining supporting tooth structure, other filling materials such as amalgam or composite resin can provide a functional alternative when the primary tooth has a life span of two years or less. The medium- to long-term treatment outcomes of pulpotomy in symptomatic permanent teeth with caries, especially in young people, indicate that pulpotomy can be a potential alternative to root canal therapy (RCT).

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Enamel hypoplasia is a defect of the teeth in which the enamel is deficient in quantity, caused by defective enamel matrix formation during enamel development, as a result of inherited and acquired systemic condition(s). It can be identified as missing tooth structure and may manifest as pits or grooves in the crown of the affected teeth, and in extreme cases, some portions of the crown of the tooth may have no enamel, exposing the dentin. It may be generalized across the dentition or localized to a few teeth. Defects are categorized by shape or location. Common categories are pit-form, plane-form, linear-form, and localised enamel hypoplasia. Hypoplastic lesions are found in areas of the teeth where the enamel was being actively formed during a systemic or local disturbance. Since the formation of enamel extends over a long period of time, defects may be confined to one well-defined area of the affected teeth. Knowledge of chronological development of deciduous and permanent teeth makes it possible to determine the approximate time at which the developmental disturbance occurred. Enamel hypoplasia varies substantially among populations and can be used to infer health and behavioural impacts from the past. Defects have also been found in a variety of non-human animals.

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<span class="mw-page-title-main">Molar incisor hypomineralisation</span> Medical condition

Molar incisor hypomineralisation (MIH) is a type of enamel defect affecting, as the name suggests, the first molars and incisors in the permanent dentition. MIH is considered a worldwide problem with a global prevalence of 12.9% and is usually identified in children under 10 years old. This developmental condition is caused by the lack of mineralisation of enamel during its maturation phase, due to interruption to the function of ameloblasts. Peri- and post-natal factors including premature birth, certain medical conditions, fever and antibiotic use have been found to be associated with development of MIH. Recent studies have suggested the role of genetics and/or epigenetic changes to be contributors of MIH development. However, further studies on the aetiology of MIH are required because it is believed to be multifactorial.

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Atraumatic restorative treatment (ART) is a method for cleaning out tooth decay from teeth using only hand instruments and placing a filling. It does not use rotary dental instruments to prepare the tooth and can be performed in settings with no access to dental equipment. No drilling or local anaesthetic injections are required. ART is considered a conservative approach, not only because it removes the decayed tissue with hand instruments, avoiding removing more tissue necessary which preserves as much tooth structure as possible, but also because it avoids pulp irritation and minimises patient discomfort. ART can be used for small, medium and deep cavities caused by dental caries.

References

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